Op.Dr. Behçet Şahin | KBB Uzmanı
Tympanoplasty Surgery

Tympanoplasty Surgery

Tympanoplasty surgery, which is applied in chronic middle ear problems, is the process of cleaning the inflammation in the middle ear and mastoid bone, and repairing the eardrum and the auditory system in the middle ear. Depending on the extent of the disease, the operation can be performed in the form of repairing the hole in the eardrum only (Myringoplasty), repairing the ossicular system that provides sound transmission in the middle ear with membrane repair (Tympanoplasty), clearing the inflammation that has progressed into the mastoid bone (Mastoidectomy) or a combination of these operations (Tympanomastoidectomy).

Is Ear Surgery Necessary?

In cases where the problem is limited to the hole in the eardrum, if inflammation is not observed only by protecting the ear from water, the surgery is performed according to the patient's preference. Hearing loss is around 30% in simple membrane perforations, and it is not obligatory to undergo surgery in these patients. On the other hand, there is a possibility of life-threatening problems in the presence of cholestatoma and inflammation that dissolves the middle ear and inner ear bones, and these patients should definitely undergo surgery.

When is Tympanoplasty Surgery Performed?

Although the ideal time for simple eardrum replacement surgery is recommended after the age of 12-14, it is imperative for patients with high inflammation rates to have surgery at any age (sometimes in emergency conditions).

In Which Situations Is Tympanoplasty Surgery Performed and What Are the Benefits?

If the ear with a hole in the membrane is protected from water or there is no infection in the nose and sinus area, if there are recurrent ear discharges, the hole in the membrane can be closed in order to improve the quality of life and to prevent the progression of hearing loss and complications due to inflammation. In patients with significant hearing loss, problems in the ossicles that transmit sound can be straighten in the same surgery. There are various surgical techniques that can be used for this purpose. With these techniques, cartilage, bone grafts or middle ear prostheses can be used. If an inflamed tissue called cholestatoma is detected in the middle ear and mastoid bone, which progresses by dissolving the bone, this inflammation should be removed with surgery as soon as possible. The protection or repair of the hearing system in patients with cholesteatoma is the second priority, and the main purpose is to clear the inflammation before it causes facial paralysis, inner ear-related hearing loss or intracranial complications (meningitis, brain abscess, etc.).

What is the Surgical Technique?

While deciding on the technique of the surgery, the condition of the disease, the location of the hole on the membrane, the shape of the ear canal, whether to intervene in the mastoid bone during the operation, the preferences of the surgeon and finally the patient should be considered. Although very different surgical techniques are applied under the microscope in the middle ear and mastoid bone during the operation, questions are frequently asked about this issue, since the patient and their relatives can see the surgery only by the incision in the skin.

Tympanoplasty surgery can be performed through the incisions made through the ear canal, in the anterior part of the auricle or behind the ear. When surgery is performed to repair only a small hole in the membrane, incisions are preferred from the inside of the ear canal or from the anterior part of the auricle, while incisions from the back of the ear are preferred in cases where intervention to the mastoid bone is required. The choice of the surgeon who will perform the operation in this regard is the main deciding factor. The most commonly used tissue in the repair of the eardrum is the temporal muscle sheath. Since this tissue is close to the surgical area, it can be easily obtained during surgery. Although the cartilage membrane in front of the ear canal or ready-made materials (such as sterile ear particles or cartilage membrane pieces that have undergone appropriate procedures) can also be used, the most reliable and economical method is the patient's own tissues.